Pericarditis

Introduction:

Pericarditis is swelling and inflammation of the pericardium, a sac surrounding your heart. It can be sudden or long-term. The most common form is acute (sudden) pericarditis. Mild cases may get better on their own, while more severe cases may require medication and hospitalization. Complications can include cardiac tamponade, which occurs when fluid builds up in the pericardium. This condition is more serious and may require hospitalization and possibly surgery. Chronic pericarditis can cause constrictive pericarditis, where the sac surrounding your heart gets tight with scar tissue and keeps your heart from working properly. It also may require surgery. Pericardial effusion (excess fluid around the heart) and constrictive pericarditis can occur together.

Signs and Symptoms:

The signs and symptoms of pericarditis vary, but the most common is sharp chest pain.

Acute pericarditis:

Stabbing pain on the left side of your chest
Pain gets worse when you breathe deeply or lie down
Low-grade fever
Muscle pain
Cough
Feelings of weakness or fatigue

Pericardial effusion:

Difficulty breathing
A bluish skin color

Constrictive pericarditis:

Difficulty breathing
Congestion in the lungs
Fatigue
Abdominal swelling

What Causes It?:

Many things can cause acute pericarditis and pericardial effusion, including viruses, bacteria, fungi, cancer, trauma to the heart (such as chest injury), drug reactions, and radiation exposure. In many cases, however, the actual cause is unknown. Constrictive pericarditis usually results from repeated (chronic) pericarditis.

What to Expect at Your Provider's Office:

Your health care provider will listen to your heart and lungs, looking for a distinctive sound the pericardium makes when it is inflamed and rubs against your heart. Your health care provider will probably order several tests, which may include blood work, an electrocardiogram (ECG), an echocardiogram, and chest x-ray.

Treatment Options:

Mild cases of pericarditis are usually treated with rest and anti-inflammatory medications, such nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen. Your health care provider may also prescribe colchicine or corticosteroid medicines. If a bacterial infection is causing your pericarditis, you will be given antibiotics. To treat recurring pericarditis, a multi-drug protocol, including NSAIDs at high dosage, slow tapering of a corticosteroid, colchicine, and close monitoring is very effective. If you develop cardiac tamponade, your doctor may recommend a procedure called pericardiocentesis, which drains fluid from your chest. Total pericardiectomy (removal of the pericardium) is also an option.

Complementary and Alternative Therapies

People with pericarditis should be under the care of a physician. Alternative therapies can be used along with conventional treatments, but it is important to determine the cause of the inflammation to treat it properly. Be sure to let your doctors know about the alternative treatments and supplements you may be using.

Nutrition and Supplements

You health care provider may recommend a low-salt diet if you have constrictive pericarditis.

Avoid saturated fats, alcohol, and sugars, which can increase inflammation and weaken your immune system.

Although there are no nutritional supplements that specifically treat pericarditis, these may strengthen your immune system and your heart health:

Vitamins C (1,000 mg up to three times per day, or a lower dose if diarrhea develops), E (400 - 800 IU per day), A (10,000 IU per day) or beta-carotene (100,000 IU per day), plus selenium (200 mcg per day), and zinc (30 mg per day), to help strengthen your immune system. Do not take this combination for more than two weeks. Ask your doctor to determine the right dose for you.
Coenzyme Q10 (200 - 600 mg per day) is an antioxidant that is good for heart health. Do not take coenzyme Q10 if you take blood-thinning medication (anticoagulants).
Magnesium (200 mg two to three times per day) helps your heart work efficiently. Magnesium interacts with many medications as well as other herbs and supplements, so talk to your doctor before taking magnesium. Do not take magnesium if you have kidney damage.
Bromelain (250 - 500 mg three times per day between meals) is an enzyme derived from pineapple. It helps fight inflammation and may increase the effectiveness of antibiotic therapy. Bromelain can increase the risk of bleeding, so ask your doctor before taking bromelain if you also take blood-thinning medication (anticoagulants) including aspirin.
Fish oil (1.5 g two times per day) helps lower inflammation over time. Fish oil can increase the risk of bleeding, so ask your doctor before taking fish oil if you also take blood-thinning medication (anticoagulants) including aspirin.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day. You may use tinctures alone or in combination as noted.

Although there are no herbs that specifically treat pericarditis, some may strengthen your immune system and your heart health. Take these herbs only under your doctor's supervision.

For heart support:

Hawthorn (Crataegus monogyna), 240 - 600 mg per day. Hawthorn has been used traditionally to treat heart problems, although it has not been studied for pericarditis.
Garlic (Allium sativum), 600 - 900 mg per day. Garlic may increase the effect of blood-thinning medications such as warfarin (Coumadin). Ask your doctor before taking garlic if you also take blood thinners..

To strengthen the immune system short term:

Echinacea (Echinacea spp.), 500 - 1,000 mg three times per day.
Goldenseal (Hydrastis canadensis), 500 - 1,000 mg three times per day; often used with Echinacea. Goldenseal can affect blood-thinning medications such as warfarin (Coumadin) and can lower blood sugar. Ask your doctor before taking goldenseal if you also take blood thinners or if you have diabetes.
Andrographis (Andrographis paniculata), 400 mg three times per day.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Some of the most common remedies used for pericarditis are listed below. The common dose is three to five pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms improve.

Aconite -- for sudden, sharp pains accompanied by anxiety (especially fear of dying) and restlessness

Spongia tosta -- for the sensation that the chest will explode, anxiety, light-headedness, sweating; patient may be flushed

Cactus grandiflorus -- for the feeling that there is a band around the chest or a great weight on the chest, or palpitations, or if your condition feels better in the open air and worse at night

Following Up:

Your health care provider may order a follow-up x-ray or electrocardiogram.

Alternative Names:

Heart infection - pericarditis

Reviewed last on: 3/28/2010
Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

Supporting Research

Ariyarajah V, Spodick DH. Acute pericarditis: Diagnostic cues and common electrocardiographic manifestations. Cardiol Rev. 2007;15(1):24-30.
Brucato A, Brambilla G, Adler Y, Spodick DH, Canesi B. Therapy for recurrent acute pericarditis: A rheumatological solution. Clin Exp Rheumatol. 2006;24(1):45-50.
Chowdhury UK, Subramaniam GK, Kumar AS, Airan B, Singh R, Talwar S, et al. Pericardiectomy for constrictive pericarditis: A clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg. 2006;81(2):522-9.
Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Med. 2004;70:293-8.
Cornily JC, Le Gal G, Tram-Lebaillif TN, Gilard M, Boschat J, Blanc JJ. Acute pericarditis: Results of a survery of treatment practices and cardiologists. Arch Mal Coeur Vaiss. 2006;99(1):61-4.
Ernst E. Cardiovascular adverse effects of herbal medicines: a systematic review of the recent literature. Can J Cardiol. 2003 Jun;19(7):818-27. Review.
Francone M, Dymarkowski S, Kalantzi M, Rademakers FE, Bogaert J. Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy. Eur Radiol. 2006;16(4):944-51.
Martin y Porras M, Waleffe A, Pierard L. Treatment of recurrent pericarditis: Case report and review of the literature. Rev Med Liege. 2007;62(1):21-24.
Pawlak-Cielik A, Szturmowicz M, Fijakowska A, Tomkowski W, Kupis W, Langfort R, et al. Neoplastic pericarditis: The role of different diagnostic procedures. Pol Arch Med Wewn. 2006;115(1):37-44.